Urinary and anal incontinence among female gymnasts and cheerleaders—bother and associated factors. A cross-sectional study

Abstract

Introduction and hypothesis Artistic gymnastics, team gymnastics and cheerleading are sports including high-impact activities. It is presumed that the athletes’ pelvic floor must be functioning well to prevent urinary (UI) and anal incontinence (AI) during sports. The aim of this study was to investigate the prevalence and risk factors for UI and AI in female artistic gymnasts, team gymnasts and cheerleaders; the influence of UI and AI on daily living and sport performance; and the athletes’ knowledge about the pelvic floor muscles (PFM). Methods All female athletes ≥ 12 years of age competing in ≥ 1 National Championship in artistic gymnastics, team gymnastics or cheerleading in 2018/2019 were invited. International Consensus on Incontinence Questionnaires were used to assess the prevalence/bother of UI and AI. Results Among the 319 gymnasts and cheerleaders who participated, the prevalence of UI and AI was 67% and 84%, respectively. Age, training ≥ 4 days/week and straining to void were significantly associated with stress urinary incontinence (SUI) and years of training with AI. Eighty-three percent of athletes with SUI reported a negative effect on sports performance, 22% would occasionally avoid training or specific exercises because of leakage, and 28% used pads for protection. Forty-one percent of the athletes had never heard about the PFM, and 74% reported an interest in PFM training to prevent/treat UI or AI. Conclusions UI and AI were prevalent in female gymnasts and cheerleaders, and SUI negatively influenced sport performance. The athletes’ knowledge about the PFM was limited.

Elite female athletes’ experiences of symptoms of pelvic floor dysfunction: A systematic review

“…Fifteen studies involved nulliparous participants [23, 24, 26, 27, 29, 31, 35, 37-39, 41, 42, 44, 45, 53] and 15 studies included both nulliparous and parous participants [8, 25, 28, 30, 32-34, 36, 40, 43, 46, 48, 50-52]. Two studies did not report information on parity of participants [47,49].…”

“…Mixed urinary incontinence (MUI) was reported as the most prevalent form of UI in one study by Cardoso et al [27]. Anorectal dysfunction (ARD) was reported in nine studies with the prevalence of constipation/straining to defecate reported in all of these studies [8,26,28,29,31,32,34,46,47] and anal incontinence (AI) reported in four studies [26,29,46,47]. The prevalence of sexual dysfunction (SD) was reported in two studies [26,29], the prevalence of POP was reported in four studies [26,29,41,46] and the prevalence of pelvic pain was reported in two studies [24,45].…”

“…The fifth and final theme Impact on emotions was reported in 9/32 (28%) studies. The following negative emotions in some athletes were reported as a consequence of PFD: 'embarrassment' in 6/9 studies [31,35,39,44,46,47]; 'fear' in 5/9 studies [38,40,44,46,47]; 'concern/anxiety/worry' in 5/9 studies [40,44,[46][47][48]; 'annoyance' in 4/9 studies [40,[46][47][48]; finally, 'frustration' was an emotion reported by some athletes in in 3/9 studies [40,46,47].…”

Development of a screening tool for pelvic floor dysfunction in female athletes: protocol of a Delphi consensus

“…These conditions could be under-recognized for several reasons. Studies showed that the athletes' knowledge of the pelvic floor muscles was low 8,11 , few had discussed their condition with coaches or medical personnel 7,8 , and only a minority of professionals were aware and consistently screened for PFD 12 .…”

“…Regarding other PFD such as pelvic organ prolapse (POP) and anal incontinence (AI) evidence are still scant 4 . These disorders could interfere not only with the athletes 'personal and social lives, but also could affect their performance [6][7][8] . Nevertheless, several authors have already discussed that it is reasonable to assume that the overall problem could be underestimated 4,9 .…”